Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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The development of clinically meaningful biomarkers for CNS traumatic injury is a major area in neurotrauma modelling. Neuroimaging is evolving as a major approach to characterize pathophysiology, improve diagnosis and test new therapies. Imaging the microglial response by targeting the up- regulation of the 18 kDa translocator protein (TSPO) following CNS injury, is a main diagnostic approach for investigating the neuroinflammatory (NI) response after CNS injury in vivo. ⋯ : This study shows the significant potential of these imaging tracers as sensitive clinical tools for non- invasive monitoring of the NI response and, potentially, of the response of NI to new therapies.
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Sepsis is a life threatening condition but its toll on human health extends way beyond the acute episode. Sepsis induced immune dysfunction has been suggested to be responsible for susceptibility to opportunistic infection, viral reactivation and reduced lifespan in sepsis survivors. ⋯ These results suggest that in addition to the short lasting endotoxin tolerance phenomenon observed with monocytes/macrophages following a first LPS encounter, another long lasting process exists at the NK cell levels, associated with a functional reprogramming. Thus, the modified immune status of NK cells long after a first LPS encounter was associated with an enhanced resistance.
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Oxidative and nitrosative stress in septic shock trigger opening of mitochondrial permeability transition (mPT) pore which contribute to additional ROS production, mitochondrial swelling, cell death, multiple organ failure (MOF) and mortality. Cyclophilin D (CypD) is a component of mitochondrial permeability transition pore complex, and disruption of CypD prevents ischemia-reperfusion, calcium overload and ROS induced mPT and necrotic cell death. No data is available in the role of CypD disruption in septic shock models. ⋯ These data show that CypD dependent mPT is an amplifier of LPS-induced mitochondrial damage, gene expressions, apoptotic pathways, and play a major role in the late phase mortality in LPS-induced septic shock. That is, CypD can be valuable drug target, and its inhibition may provide a novel possibility to reduce mortality in septic shock.
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There is increasing evidence for the existence of a Trauma-Induced Secondary Cardiac Injury (TISCI), which, with resultant cardiac dysfunction, contributes to late mortality and morbidity in severely injured patients. The aim of my study was to demonstrate that cardiomyocyte injury induced by trauma, reflected by H-FABP, correlates with echocardiographic markers of cardiac function. ⋯ This study has demonstrated the dose-dependent relationship of H-FABP release with the severity of trauma haemorrhage and measured cardiac function. The release of H-FABP from the myocardium into the circulation correlates with the severity of the haemodynamic challenge with the highest values correlating with the lowest MAP (Fig. 1) and cardiac output (Fig. 2). The functional data presented here strengthens the case for H-FABP as a useful biomarker in the identification and stratification of TISCI.(Figure is included in full-text article.)(Figure is included in full-text article.).
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A classification of hypovolemic shock based on the shock index (SI) was proposed in 2013. This classification containing four classes correlates well with acidosis, blood product need and mortality. Their applicability in multiple injured patients with traumatic-brain-injury (TBI) was questioned. The aim of this study was to verify the validity of the new classification in these patients. ⋯ The presented classification of hypovolemic shock based on the SI enables a fast and reliable assessment of hypovolemic shock. Regardless of the presence of TBI, no clinical differences in transfusion requirements occurred within the four classes of hypovolemic shock. Therefore, the classification is a feasible tool to assess patients at risk for blood product transfusions, even in the presence of severe TBI.